Inside a Montreal clinic struggling to cope with health reforms imposed by Quebec

As a family doctor, Hiromi Tissera prides herself on taking a compassionate approach to her patients.

She says that will be more difficult because of the goals outlined in the Quebec government’s new health reforms, known as Bill 2.

“We will be penalized for spending extra time with patients because we have to meet certain targets, and I don’t think that’s how it should be done,” said Ticera, a family physician who works at District Medical in Montreal’s Ahuntsic neighbourhood.

Providing the best care takes time, Ticera said. In his view, it means taking some time to sit down with patients, make eye contact and ask, “What can I do for you?”

“They are exposing their most vulnerable moments to us and making them feel comfortable is extremely important,” Ticera said.

Premier Francois Legault has said the changes, which include tying a portion of doctors’ salaries to collective performance targets, will benefit the 1.5 million Quebecers who don’t have a family doctor.

But there is an uproar among doctors over the reforms – which were Forced through the National Assembly last month, and many are threatening to leave the province.

District Medical, one of the city’s largest family medicine clinics, has lost nine of its 51 family physicians since the Coalition Avenir Quebec government first introduced its health reform law last spring.

According to its medical director, Dr. Georges Zarrour, some retired, others went back to school or transferred to other positions and two moved elsewhere in Canada.

Ticera is also considering moving to Ontario. He is one of the more 260 doctors Who had recently applied to work in a neighboring province.

‘We feel very, very humiliated’

District Medical is known as GMF, the French acronym for Family Physician Group. GMFs are public-private partnerships, often owned by physicians.

they are They are financed through a combination of provincial funding and a portion of the revenue generated by the physicians who operate them.

Many of those physicians have expressed concerns about the reforms. Earlier this week, 18 GMF doctors in Montreal signed a letter condemning Bill 2, which was first reported. montreal gazetteThe letter said the reforms would jeopardize their financial model,

While not all district medical departures can be directly attributed to the government changes, Zarour said apprehension about the changes hasn’t helped.

“The mood is very bad. We have been insulted,” he said. “We feel very humiliated coming out of a pandemic with a roll up our sleeves that everyone has taken.”

Zarour’s clinic has grown rapidly since it was established in 2020 with six physicians and one secretary. The team now consists of 60 doctors and 60 support staff, and serves 55,000 patients. It provides a range of services including family medicine, paediatrics, physiotherapy and urgent care.

Strict targets, at what cost?

Zarour said one reason for its success is that the clinic has made it easier for doctors to focus on medical care — while support staff handle administrative tasks.

Now the government is setting strict targets for them.

“It’s going to be, ‘I used to see 20 patients, tomorrow, I have to see 40 patients to be able to hit those government goals,'” Zarour said. He said, this will put huge pressure on doctors.

The law also assigns patients to doctors according to their level of sensitivity.

Family physicians say this will make it difficult for healthy children to get care so that doctors can catch problems before they develop into major problems.

Another doctor, Dr. Sabreen Manoli, said it is a fundamental part of her job.

“With children, the truth is that we spend a lot of time preventing them from developing pathologies,” he said.

“Children are amazing. If you help them early on, we can prevent all this.”

Government says reforms meant to improve access

In a statement responding to these concerns, Quebec’s Ministry of Health said the changes are not intended to force doctors to see more patients, but to improve access by tailoring care to people’s clinical needs.

The new vulnerability classification will guide access and funding, but a ministry spokesperson said, “It is wrong to assume that people who are not classified as vulnerable will have less access to care.”

Marie-Christine Patry said, “Access will always depend on clinical need, not on the state of vulnerability.”

The law is designed to allow doctors to take on the most difficult cases and delegate less difficult cases to other health professionals such as nurses, pharmacists and physiotherapists, said Professor Olivier Jacques of the School of Public Health at the Université de Montréal.

In theory, he said, the change would make it possible for GMF’s doctors to receive even better compensation. He said the concern over eliminating preventive medicine would be more meaningful if the current model is working.

“I’m not convinced that the new system will actually cause much of a problem to prevent,” he said. “We’re starting at the very bottom.”

Cosette Wahba, who was at the clinic earlier this week with her three-year-old daughter, said she was saddened by the ongoing controversy.

“I find it a little sad that people don’t agree,” he said. “I think everyone should be involved in finding solutions in any situation.”

She said she’s grateful she has access to care and knows many people in Quebec don’t have that access.